What is menopause?

Signs and symptoms of menopause are usually enough to tell most women that they’ve started the menopausal transition. If you have concerns about irregular periods or hot flashes, talk with your doctor. In some cases, further evaluation may be recommended.

Tests typically aren’t needed to diagnose menopause. But under certain circumstances, your doctor may recommend blood tests to check your level of:

• Follicle-stimulating hormone (FSH) and estrogen (estradiol), because your FSH levels increase, and estradiol levels decrease as menopause occurs
• Thyroid-stimulating hormone (TSH) because an underactive thyroid (hypothyroidism) can cause symptoms similar to those of menopause

Over-the-counter home tests to check FSH levels in your urine are available. The tests could tell you whether you have elevated FSH levels and might be in perimenopause or menopause. But, since FSH levels rise and fall during the course of your menstrual cycle, home FSH tests can’t really tell you whether or not you’re definitely in a stage of menopause.

Treatment

Menopause requires no medical treatment. Instead, treatments focus on relieving your signs and symptoms and preventing or managing chronic conditions that may occur with aging. Treatments may include:

• Hormone therapy. Estrogen therapy is the most effective treatment option for relieving menopausal hot flashes. Depending on your personal and family medical history, your doctor may recommend estrogen in the lowest dose and the shortest time frame needed to provide symptom relief for you. If you still have your uterus, you’ll need progestin in addition to estrogen. Estrogen also helps prevent bone loss. Long-term use of hormone therapy may have some cardiovascular and breast cancer risks, but starting hormones around the time of menopause has shown benefits for some women. Talk to your doctor about the benefits and risks of hormone therapy and whether it’s a safe choice for you.
• Vaginal estrogen. To relieve vaginal dryness, estrogen can be administered directly to the vagina using a vaginal cream, tablet or ring. This treatment releases just a small amount of estrogen, which is absorbed by the vaginal tissues. It can help relieve vaginal dryness, discomfort with intercourse and some urinary symptoms.
• Low-dose antidepressants. Certain antidepressants related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs) may decrease menopausal hot flashes. A low-dose antidepressant for management of hot flashes may be useful for women who can’t take estrogen for health reasons or for women who need an antidepressant for a mood disorder.
• Gabapentin (Gralise, Horizant, Neurontin). Gabapentin is approved to treat seizures, but it has also been shown to help reduce hot flashes. This drug is useful in women who can’t use estrogen therapy and in those who also have nighttime hot flashes.
• Clonidine (Catapres, Kapvay). Clonidine, a pill or patch typically used to treat high blood pressure, might provide some relief from hot flashes.
• Medications to prevent or treat osteoporosis. Depending on individual needs, doctors may recommend medication to prevent or treat osteoporosis. Several medications are available that help reduce bone loss and risk of fractures. Your doctor might prescribe vitamin D supplements to help strengthen bones.

Before deciding on any form of treatment, talk with your doctor about your options and the risks and benefits involved with each. Review your options yearly, as your needs and treatment options may change.

What you can do?

Before your appointment:

• Keep track of your symptoms. For instance, make a list of how many hot flashes you experience in a day or week and note how severe they are.
• Make a list of any medications, herbs and vitamin supplements you take. Include the doses and how often you take them.
• Ask a family member or close friend to accompany you, if possible. You may be given a lot of information at your visit, and it can be difficult to remember everything.
• Take a notebook or notepad with you. Use it to record important information during your visit.
• Prepare a list of questions to ask your doctor. List your most important questions first.

Some basic questions to ask include:

• What kind of tests might I need, if any?
• What treatments are available to minimize my symptoms?
• Is there anything I can do to relieve my symptoms?
• What steps can I take to maintain my health?
• Are there any alternative therapies I might try?
• Do you have any printed material or brochures I can take with me?
• What websites do you recommend?

In addition, don’t hesitate to ask questions at any time during your appointment.

What to expect from your doctor?

Some questions your doctor might ask include:

• Are you still having periods?
• When was your last period?
• How often do you experience bothersome symptoms?
• How uncomfortable do your symptoms make you?
• Does anything seem to improve your symptoms?
• Does anything make your symptoms worse?